Lateral Pivot-Shift Test of the Elbow
What is Lateral Pivot-Shift Test of the Elbow?
Lateral Pivot-Shift test of the elbow or as called (Posterolateral Apprehension Test) is used for Lateral Ulnar Collateral Ligament Injury (PLRI) which causes posterolateral instability of the elbow.
How it's Performed?
- Patient lies supine with affected arm overhead.
- forearm is supinated and valgus stress is applied while bringing the elbow from full extension to 40 degrees of flexion.
- with increased flexion triceps tension reduces the radial head.
- often more reliable on anesthetized patient.
What does a positive Lateral Pivot-Shift Test of the Elbow mean?
Lateral Pivot-Shift test of the elbow is considered positive when:
- At 40° of flexion, the patient with posterolateral rotatory instability will note apprehension/pain as the radial head subluxates about the capitellum.
- With further flexion, a clunk or sense of relief occurs as the joint is reduced.
Sensitivity & Specificity
- Sensitivity: 100 % (In anesthetized patients)
- Sensitivity: 38 % (In awake patients)
- Because of the anatomical fact that the arm normally has a valgus orientation and load, mild varus instabilities remain unnoticed clinically. Mild valgus instabilities are more likely to be present.
- Clinical Tests for the Musculoskeletal 3rd Ed. Book